Women who have PCOS are able to become pregnant.

Polycystic ovary syndrome (PCOS) is a common endocrine and reproductive disorder among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

Prevalence estimates ranging from 2.2% to as high as 26%

What is the cause for PCOS?

The cause of polycystic ovary syndrome isn’t well understood, but may involve a combination of genetic and environmental factors.

What are the symptoms of PCOS?

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later.

• Irregular periods– Infrequent, irregular or prolonged menstrual cycles or sometimes fewer than eight periods a year or none at all.
• Excess hair growth on face, chest and back. Excess hair growth is called hirsutism.
• Acne
• Male pattern baldness
• Hair loss
• Raised, velvety brown discoloration over the nape of neck, underarms, elbows, groins and under the breasts
• Weight gain

How PCOS affects the body?

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later.

• Infertility
• Miscarriage or premature birth
• Metabolic syndrome –includes high blood pressure, high blood sugar, excess body fat around the waist, abnormal cholesterol levels. All these increase the risk of cardiovascular disease, diabetes and stroke
• Sleep apnea, which is more common in overweight women
• Depression and anxiety
• Eating disorders
• Abnormal uterine bleeding
• Endometrial cancer

How to diagnose PCOS?

Ultrasound – look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium)

Blood tests – look for

• High levels of androgens ( total and free testosterone )
• Elevated LH ( Luteinising hormone )
• Normal FSH (Follicle stimulating hormone )
• Elevated LH/FSH ratio ( >3:1 )
• Low SHBG ( sex hormone binding globulin )
• Mildly elevated prolactin
• Elevated fasting insulin
• Abnormal GTT ( Glucose tolerance test ) and Dyslipidemia.

What is the management for PCOS?

• Lifestyle choices and diet in PCOS play an important role in managing its symptoms
• Lifestyle modification – means change in diet and activity. A healthy diet and more physical activity can help in losing weight and reduce the symptoms. Also help the body to use insulin more efficiently, lower blood glucose levels, and may help in ovulation.
• Diet- balanced and hypocaloric diet
• Exercise- daily strict physical activity sessions for at least 30min/day or 150min/week
• Smoking cessation
• Metformin for glucose intolerance
• To regulate the menstrual cycles
  • Oral contraceptive pills – contain estrogen and progestin. These are given in women who do not wish to conceive. They decrease androgen production and regulate estrogen. Also lower the risk of endometrial cancer, excess hair growth and acne.
  • Progestin therapy for 10- 14 days in a month can regulate the periods and protect against endometrial cancer.
• To reduce excess hair growth
  • Anti-androgens : spironolactone, combined oral contraceptive pills, flutamide
  • Waxing, plucking, shaving, depilation, electrolysis and laser to remove current hair

What are the foods to avoid for PCOS?

• Starchy vegetables such as sweet potato, yam, peas, corn. Starchy vegetables are rich in carbohydrates and quickly increases blood sugar levels, causes an imbalance in hormones
• Fruit juices, processed fruit concentrates and canned fruit – contain high doses of added sugar.
• Vegetable oils – contain high ratio of omega -6 fatty acids. They are linked to obesity, cancer, diabetes and heart disease
• Sugary foods – Gulab jamun, kulfi, halwa, cakes, cookies, and kheer
• Fried foods – pakoras, samosas. These are rich in saturated and hydrogenated fats. They can increase estrogen production
• Refined and processed foods- white bread, white rice, instant oatmeal, rice cakes and white pasta. These are stripped of fibre
• Red meat
• Alcohol and caffeine

What are the best foods for PCOS?

• High fibre vegetables such as broccoli, spinach, green beans, cauliflower, snake gourd, carrots. These are high in fibre and helps in maintaining blood sugar levels and reverses insulin resistance. PCOS diet should contain at least 25grams of fibre daily.
• Pulses – split peas, green moong, yellow moong, dried beans, chana dal, lentils, soybeans and chickpeas. Pulses are low glycemic food.
• Whole grains – whole wheat, brown rice, oats, poha and barley. These are rich in fibre and unprocessed carbs.
• Lean protein – egg protein, skinless chicken, fish, skimmed milk.
• Nuts and seeds such as almonds, hazelnuts, flaxseeds, pine nuts.
• Indian spices and herbs such as fenugreek, cinnamon, turmeric, mint, tulsi, ginger and cloves. These are all helpful in regulating insulin levels.

Can women get pregnant with PCOS?

Yes, women who have PCOS are able to become pregnant.

This includes

• Preconception counselling
  • Positive counselling
  • Counselling on the need for identification and correction of long term risk factors affecting fertility before initiating treatment
  • Regarding diet, lifestyle, cessation of smoking and folic acid intake
• Ovulation induction agents
  • Medications can help the ovaries to release eggs normally. They can increase the chance for a multiple birth (twins or more). And they can cause ovarian hyperstimulation, occurs when the ovaries release too many hormones. It can cause symptoms such as abdominal bloating and pelvic pain.
  • Clomiphene citrate – it is a selective estrogen receptor modulator. Dose : 50mg/day for 5 days from day 2/3
  • Letrozole
  • Gonadotrophins
• Insulin sensitizing agents
  • Associated with a reduction in serum androgen levels and gonadotropins
  • These are proposed as the therapy of choice for polycystic ovary syndrome (PCOS), since insulin resistance and associated hyperinsulinemia are recognized as important pathogenetic factors of the syndrome
  • They are metformin, rosiglitazone, pioglitazone and inositol
• Other adjuncts for improvement in metabolic function
  • N-Acetyl cysteine – decreases insulin and cholesterol, increases ovulation rate and pregnancy rates
  • Vitamin D supplementation – beneficial effects on insulin resistance, decreases androgen levels and improves ovulation
  • Anti-oxidants : omega-3 fatty acids, chromium, zinc and soy phytoestrogens
  • Corticosteroids: decreases androgen levels. Dexamethasone or prednisone are used
  • L-Methylfolate

Reviewed By:

DR.R VIDYACHAYA

SENIOR CONSULTANT – OBSTETRICS & GYNAECOLOGY

MBBS, DGO, MS (OG), DNB (OG) , FMAS